Introduction: Conjunctival neoplasms span from benign lesions to life-threatening malignancies. A wide range of treatment modalities has been developed, spanning from observation, simple excision and topical chemotherapy to advanced surgical techniques combined with adjuvant therapies including cryotherapy, topical and systemic chemotherapy, immune-modulating agents, anti-viral therapy, and radiotherapy. Areas covered: This review provides an overview of treatment modalities employed in conjunctival neoplasms as well as management guidelines for selected groups of conjunctival tumors. A literature search was performed using the keywords ‘Conjunctival neoplasms’ [MeSH], ‘Conjunctival AND neoplasia’, ‘Conjunctiva AND neoplasia’, ‘Conjunctival tumors’ in combination with ‘Chemotherapy’, ‘Topical chemotherapy’, ‘Mitomycin C’, ‘5-fluorouracil’, ‘Interferon alpha 2b’, ‘anti-VEGF’, ‘Brachytherapy’, ‘Radiation’, ‘Radiotherapy’, ‘Cryotherapy’, ‘Surgery’, ‘Systemic chemotherapy’, and ‘Lymphoma’. Expert commentary: The efficacy of the different adjuvant therapies is debated. However, there is no doubt that adjuvant therapy reduces the risk of recurrence. Therefore, we recommend that ocular oncologists use an adjuvant therapy together with surgery for conjunctival melanoma. The treatment of malignant conjunctival tumors should be centralized in each country and placed in a few hands. This, combined with large multicenter studies, will provide valuable new information, benefit our patients, and improve the prognosis in the future.